PONE-D-24-34705Perceptions, experiences, barriers, facilitators, learning outcomes, and modes of assessment of digital clinical placements for pre-registration physiotherapy students internationally: a systematic review protocolPLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

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Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

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(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1&2 :  Thanks for the invitation to review this manuscript. For context, this review has been completed asynchronously by two academics, and then discussed collectively to evaluate the quality of our review. We’ve labelled our comments below accordingly for your context. The overarching topic is interesting and relevant for the physiotherapy profession and broadly digital healthcare, and the methodological approach is excellent. Overall, we believe the outcomes of this review will offer important contributions to the study and practice of digital clinical placements for the physiotherapy profession. Nevertheless, below we report several comments for your consideration, which are essentially ‘minor’ in nature. We genuinely consider the review process an academic debate, so encourage you to think critically about our feedback and offer theoretically and/or empirically justified responses where you disagree with our recommendations/comments.

1 R1: I appreciated reading an entire section devoted to the definition of digital clinical placements. As you acknowledge, the diversity of definitions within existing literature indicates the need for clarity, at least how it pertains to the current work. However, I wonder if you could tighten your current approach, so that a single statement captures the essence of this concept rather than the definition being spread across three individual statements. For example, perhaps something like “healthcare delivered a/synchronously by trainees under the supervision of registered professionals to human patients entirely or partially via information and communication technology” might work well. FYI, this paper by Podsakoff and colleagues (https://journals.sagepub.com/doi/full/10.1177/1094428115624965) is my ‘go to’ reference when it comes to thinking about high-quality concept definitions.

2. R2: In the section titled ‘the state of the evidence’, the evidence provided comes from two reviews on this topic, each of which references a single article pertaining to physiotherapy student placements. Despite this being a relatively under-explored topic of research in the physiotherapy profession, there are other journal articles (not captured by the aforementioned reviews) that could be included in this section to provide a more comprehensive overview of the topic of interest. Here are just a few examples, within physiotherapy, that could be considered for inclusion:

• https://doi.org/10.5195/ijt.2022.6464

• https://doi.org/10.53300/001c.32992

• https://doi.org/10.53300/001c.24960

• https://doi.org/10.11157/fohpe.v23i3.595

• https://doi.org/10.1002/msc.1723

• https://doi.org/10.1002/hsr2.2067

R1: I have a couple of reflections regarding the section titled ‘the state of the evidence’:

• Line 114: a single paper among how many? This context is important to help readers appreciate the essence of your reflections on their work.

• I believe you could sharpen your critical evaluation of their methodology to strengthen the gap you address here. For example, authors of this prior work may have set out to scope perspectives broadly across allied health rather than in-depth for any specific discipline. If so, your critical evaluation could be considered a strength to some extent rather than a weakness, or at least an artifact of their guiding research questions (I suspect the search strategy to capture everything across all health sciences would be complex and capture a lot of irrelevant work). Expanding the points you mention also seems important. For example, what is the value of the additional search strategies you mention (e.g., increase the likelihood that we capture most if not all relevant data)?

3. R2: In objective 1 you state ‘digital/online clinical placements’ whereas objectives 2 and 3 simply state ‘digital clinical placements’. In light of your stated definition of ‘digital clinical placements’ (lines 91-92), it would be appropriate to delete the word ‘online’ in objective 1 for consistency.

4. R1: General writing comment: people are ‘who’ or ‘whom’ rather than ‘that’ (e.g., Table 1 “Clinical educators that have experience…”).

5. R2: Minor typographic errors:

• In Table 1 Inclusion criteria (page 14): “… using …” should read “… uses …”

• Line 294: “asses’ should read “assess”

• Table numbers appear incorrect i.e., there are two (2) Table 1’s referenced within the body of the paper (page 14 and page 26)

• In Table 1 Confidence in Cumulative Evidence (last column on page 26) and Table 2 Summary of Confidence in Cumulative Evidence (last column on page 27): “… rating give in the …” should read “… rating given in the …”

6. R1 and R2: The systematic review protocol is excellent – well done. We have a few reflections for your consideration:

• Regarding data items, you might consider adding philosophical positioning to the list, as you’ll likely access mostly qualitative studies in which this information is central to assessments of rigor. Relatedly, you also might like to add your philosophical positioning for this work so that readers can appreciate key concepts like ontology and epistemology as it relates to your efforts.

• Since you are targeting assessment modes, learning outcomes, beliefs, etc…, it is possible these aspects could be overlooked (e.g. if captured via standardized self-reports) if only accessing qualitative and mixed methods designs. As such, you could consider expanding the inclusion criteria to also include Quantitative studies. Alternatively, you may need to provide a rationale for why you are excluding quantitative only studies and edit the research objectives accordingly.

• Lines 237-240: This statement could be strengthened so that readers can appreciate exactly what you plan to do here. I’m unsure that one can collate and summarise ‘themes’ among a body of work with no interpretation on the part of analysts. You might not be interpreting the original work per se but nevertheless are ‘filtering’ that information in some way (i.e., you are an active driver rather than passive passenger). Relatedly, what exactly do you mean by a theme here?

7. R1: I preface this comment with my general impression that the QuADS and GRADE-CERQual appear reasonable enough for your purposes. Nevertheless, I also would like to add that quality appraisals and confidence in evidence for qualitative research are notoriously complex and, therefore, ‘one size fits all’ approaches are typically considered inadequate by qualitative experts (for which I am not!). As one example, Smith and McGannon eloquently explained the complexities of rigour for qualitative research in this paper (https://www.tandfonline.com/doi/full/10.1080/1750984X.2017.1317357). Brett Smith and others have written extensively on such issues (e.g., https://doi.org/10.1016/j.psychsport.2009.02.006, https://www.tandfonline.com/doi/full/10.1080/1612197X.2019.1637363).

8. R2: Regarding data synthesis, I fully appreciate the desire to focus your meta-aggregation on commonalities among existing work. Nevertheless, as a thought-provoking comment, you also might like to consider ‘exceptions’ within the existing body of work and how they might shed light on your research questions. Phoenix and Orr wrote an excellent piece that might provide inspiration for you (https://www.tandfonline.com/doi/full/10.1080/2159676X.2017.1282539).

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Reviewer #1: No

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Perceptions, experiences, barriers, facilitators, learning outcomes, and modes of assessment of digital clinical placements for pre-registration physiotherapy students internationally: a systematic review protocol

PONE-D-24-34705R1

Dear Dr. McConnell

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Academic Editor

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Additional Editor Comments (optional):

Thank you for your correspondence in relation to altering the date of your proposed systematic review search.

I have noted this and have sent it on the section Editor as an important amendment;

Line 250 replace ‘to the 31st of May 2024’ with “to the 22nd January 2025”.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Many thanks for your efforts in addressing our feedback or providing rationales in cases where you disagreed with our comments. Overall, we believe the paper is strengthened after this round of reviews. We have no additional feedback. We look forward to reading the full paper with results once available.

The only one minor revision that could be considered is the addition of a word to complete the one sentence (lines 159-162) e.g., '... digital settings"

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

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